Re: [ozmidwifery] letter writing time

Wed, 03 May 2006 01:25:55 -0700

Dear New Idea,

 

Unsurprising as it is to see a surgeon promoting unnecessary surgery as on a par with a normal physiological process refined by millions of years of evolution, it is poor and irresponsible journalism to present these dangerous misconceptions in a major women’s magazine unchallenged. While Dr Pecoraro responsibly mentions that caesareans come with a higher rate of maternal death than vaginal births (and some other uncommon risks), he omits to mention the long list of other potential complications arising from surgery. This is an insult to your readers, since at least 1 in 3 Australian women (and 1 in 2 in many private hospitals) will have experienced this surgery and many will have had to manage the complications he clearly views as unimportant.[1] Let me list a few:

  • significantly increased risk of hysterectomy
  • significantly increased risk of PND and PTSD
  • significantly increased risk of rehospitalisation

 

 

Most scarily of all however Dr Pecoraro entirely omits the equally long list of dangers to babies from surgery. As babies born by elective caesarean are by definition premature, or they would already have left their mothers’ bodies by the more optimal path by which they entered, they not only have to deal with major narcotics passing into their bloodstream from the anaesthesia administered to their mothers, but they are unprepared to breathe and do not receive the massaging benefit that vaginal birth gives to expel mucus and help wet lungs to breathe as well as the host of friendly flora which babies need to inhabit their gut which can only be taken up in a vaginal birth. No doubt Dr Pecoraro would be the first to say that the ultimate goal from birth is a healthy baby, yet clearly the least healthy  babies of all are born via unnecessary surgery. Healthy babies also deserve healthy mothers and no woman with a massive wound in her belly could be considered a model of health by any standard, could she? Especially if that surgery was not performed as a life saving measure for her or her baby but because a surgeon told her it was safer. Let me list some for you:

  • approximately five times the rate of severe breathing problems occurring in comparison with vaginally birthed babies[2]

·        significant problems from epidural anaesthesia such as lowered neurobehavioral scores on newborn, decrease in muscle tone and strength, respiratory depression in baby, foetal malpositioning, foetal heart rate variability, increased need for forceps, vacuum and caesarean deliveries and episiotomies[3]

Difficulties with breastfeeding and bonding are also surely crucial in the early life of a baby and are far more likely with caesareans.

 

NI should be very careful what they see fit to promote because irresponsible promotion of unnecessary surgery does not save or enhance lives. Promotion of woman-centred care provided via the midwifery model, with it’s attendant lowering of caesareans and raising of women’s joy in birth is what is desperately needed in this country. Your readers deserve accurate, unbiased information from which to begin their researching, not rubbish like this which serves no one’s interests but that of surgeons.

 

Janet Fraser

[1] Other things being equal, is a caeserean section always more hazardous to the mother's health than vaginal birth?

A quick summary by Olubusola Amu, Sasha Rajendran and Ibrahim I Bolaji,
BMJ 1998;317:462-465 ( 15 August )
http://www.bmj.com/cgi/content/full/317/7156/462

"Caesarean sections are not without complications and consequences. Maternal risks in the short term include haemorrhage, infection, ileus, pulmonary embolism, and Mendelson's syndrome. The prevalence of hysterectomy due to haemorrhage after caesarean section is 10 times that after vaginal delivery, and the risk of maternal death is increased up to 16-fold.

Long term morbidity including formation of adhesions, intestinal obstruction, bladder injury, and uterine rupture is often underestimated during subsequent pregnancy. There is evidence suggesting decreased fecundity, increased risk of ectopic pregnancy, placenta praevia, and worse infant outcome in subsequent pregnancies, although the effect on non-reproductive health is unclear and contradictory. Feelings of inadequacy, guilt, and failure in not completing a natural process may affect bonding between mother and infant, particularly if the operation was conducted under general anaesthetic"

 

[2] High Rate of Persistent Pulmonary Hypertension Seen in Babies Born by C-Section

From Medscape:

WESTPORT, CT (Reuters Health) Mar 01 - The incidence of persistent pulmonary hypertension in newborns delivered by cesarean section is nearly five times higher than that observed among babies delivered vaginally, according to a database analysis of deliveries at the Illinois Masonic Medical Center, in Chicago.

Among 25,318 deliveries between 1992 and 1999, 4301 were cesareans, report Dr. Elliot M. Levine and associates in the March issue of Obstetrics & Gynecology. The incidence of persistent pulmonary hypertension was 4.0 per 1000 live cesarean births, compared with 0.8 per 1000 live vaginal births.

The authors suggest that labor and vaginal delivery, perhaps by physical compression in the birth canal, is advantageous for the pulmonary vascular bed of the neonate. They advise obstetricians to discuss the increased risk of pulmonary hypertension associated with cesarean section when offering a woman delivery options.

Obstet Gynecol 2001;97:439-442.

 

[3] International Epidural Awareness Program http://www.nt.net/lerouxma/complications.htm#baby

----- Original Message -----
Sent: Wednesday, May 03, 2006 4:56 PM
Subject: RE: [ozmidwifery] letter writing time

I’d love to read your letter Janet if you would like to share it?

Best Regards,

Kelly Zantey
Creator, BellyBelly.com.au
Gentle Solutions From Conception to Parenthood
BellyBelly Birth Support - http://www.bellybellycom.au/birth-support

From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Janet Fraser
Sent: Wednesday, 3 May 2006 4:33 PM
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] letter writing time

 

This deserves a few letters. I've sent mine, who's next?

J

 

Birth Choices - this week's NI

Should you have a caesarean or is a natural birth better? Studies show 80 per cent of gynaecologists opt for a caesarean, according to Brisbane gynaecologist Dr Gino Pecoraro.

The upside of a C-section is its quick and you can choose the delivery time, which can make it easier for your husband to be with you.

The downside is there's more risk to the mother, due to blood clots, infection and also a risk of DVT (deep vein thrombosis).

"Generally, the procedure is very safe", Dr Pecoraro says. "In Australia, only one in 10,000 women die through childbirth, with these figures somewhat higher for caesarean births.

"While the upsides of a natural birth mean no scarring, the downside includes risks of uncontrolled tearing, a long and painful labour and sometimes incontinence."

Dr Pecoraro warns there are dangers in having a caesarean for your first birth and then a vaginal delivery for subsequent babies.

"Women whose first birth is a caesarean - as choice or emergency - and then have a second birth vaginally have a slight risk (one in 200) of rupturing the scar on their uterus from the caesarean, which can be fatal".

 

 

 

For home birth information go to:
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http://www.joyousbirth.info/
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